key: cord-1025430-wflbdae6
authors: Simand, Celestine; Bund, Caroline; Guffroy, Blandine; Chaban, Vitaliy; Herbrecht, Raoul
title: Incidental Discovery of a COVID-19 Infection on a Reevaluation FDG PET/CT in a Patient Treated for Hodgkin Lymphoma
date: 2020-06-08
journal: Clin Nucl Med
DOI: 10.1097/rlu.0000000000003144
sha: 842c273f79155a88f7a0164368e108873cef7667
doc_id: 1025430
cord_uid: wflbdae6

We report the results of (18)F-FDG PET/CT in an asymptomatic case of COVID-19 infection. A 27-year-old woman underwent FDG PET/CT for revaluation of a stage IIIE B Hodgkin lymphoma after the fourth cycle of chemotherapy. It showed intense avid FDG subpleural mixed ground-glass and consolidative lesions, especially in the left lung. Because of this morpho-metabolic aspect and the epidemic context, a viral pneumopathy was suspected. The patient who was initially asymptomatic was admitted for fever 28 hours after the PET/CT. The nasopharyngeal swab was positive for COVID-19, and the outcome was favorable.

FIGURE 1. MIP 3D imaging, before chemotherapy (A) and after the fourth cycle (B). We have incidentally diagnosed a pulmonary infection in an asymptomatic 27-year-old woman on a reevaluation PET/CT after 4 cycles of chemotherapy. Stage IIIE B Hodgkin lymphoma was diagnosed in November 2019. Initially, the disease extended to pelvic, retroperitoneal, celiac, mediastinal, internal mammary, supraclavicular, and cervical lymph nodes, as well as to the spleen and local extension to the pericardium and left lung. Dose-escalated BEACOPP chemotherapy was initiated on December 5, 2019. 1 PET/CT showed a metabolic complete remission after 2 cycles. Cycle 4 was started on March 3, 2020, and ended on March 10, 2020. A reevaluation PET/CT was performed on March 18, 2020. CT scan showed bilateral pulmonary infiltrates and subpleural pseudonodular mixed ground-glass and consolidative lesions. The MIP image showed several areas of FDG avidity predominantly in the lower base of the left lung. Bone marrow avidity is related most likely to recovery from aplasia under filgrastim administration. infections are well known with data on more than 2000 patients. [2] [3] [4] [5] Most frequent patterns are ground-glass opacities, consolidation or combination of both. Interlobular septal thickening, reticular pattern, crazy paving, bronchial wall thickening, pleural thickening, pleural effusion, nodules, reversed halo sign, pericardial effusion, and lymphadenopathies are additional possible manifestations. PET/CT aspects are poorly known with only 5 cases reported in literature. [6] [7] [8] Qin et al 6 reported FDG PET/CT aspects of 4 patients with a COVID-19 infection. Ground-glass opacities were present in all patients; consolidation and interlobular septal thickening were present in one case each. Three patients also had FDG-positive lymph nodes localized in hilar, mediastinal, subclavicular, or supraclavicular regions. SUV max of the lung lesions ranged from 4.6 to 12.2. Zou and Zhu 7 reported FDG PET/CT aspects in a febrile patient with suspicion of malignancy on a chest CT. SUV max of the lung lesion was 4.9. Paratracheal and hilar lymph nodes were noted. Although there is no indication for PET/CT in COVID-19-infected patients, our case shows this infection can be discovered incidentally on surveillance PET/CT. In the context of the COVID epidemic, avid FDG ground-glass opacities, consolidation or combination of both patterns, require investigations to identify a potential COVID-19 infection.

BEACOPP, a new dose-escalated and accelerated regimen, is at least as effective as COPP/ABVD in patients with advanced-stage Hodgkin's lymphoma: interim report from a trial of the German Hodgkin's lymphoma study group

Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases

Clinical characteristics of coronavirus disease 2019 in China

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Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection

18 F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases

FDG PET/CT of COVID-19

The potential added value of FDG PET/CT for COVID-19 pneumonia